Constipation and the Quality of Life in Conservatively Treated Chronic Kidney Disease Patients: A Cross-sectional Study

Abstract

Background: Constipation is a common gastrointestinal disorder that in general population is associated with worse health-related quality of life (HRQoL). The epidemiology of constipation has not been reliably determined in conservatively-treated CKD patients. We aimed to determine the prevalence of constipation and constipation-related symptoms in conservatively-treated CKD patients, to find factors associated with their altered prevalence ratio (PR), and to verify the associations between constipation and HRQoL. Methods: In this cross-sectional study, 111 conservatively-treated CKD outpatients fulfilled questionnaires that included questions addressing HRQoL (SF-36v2®), constipation-related symptoms (The Patient Assessment of Constipation‐Symptoms questionnaire), the Bristol stool form scale (BSFS), Rome III criteria of functional constipation (FC), and frequency of bowel movement (BM). Results: Depending on the used definition, the prevalence of constipation was 6.6-28.9%. Diuretics and paracetamol were independently associated with increased PR of BSFS-diagnosed constipation (PR 2.86, 95% CI 1.28-6.37, P = 0.01) and FC (PR 2.67, 95% CI 1.07-6.64, P = 0.035), respectively. The most commonly reported symptoms were bloating (50.9%) and straining to pass a BM (42.7%). Abdominal discomfort (37.3%) was independently associated with worse scores in all analyzed HRQoL domains. In multiple regressions, FC and having <7 BM/week, but not BSFS-diagnosed constipation, were associated with lower scores in several HRQoL domains. Conclusions: Constipation and related symptoms are prevalent in CKD patients. FC and decreased frequency of defecation, but not BSFS-diagnosed constipation, are associated with worse assessment of HRQoL in conservatively-treated CKD patients.

Associations between constipation symptoms and the sleep quality in non-dialysis chronic kidney disease patients: a cross-sectional study

“…This study was conducted as part of a broad project that aimed to comprehensively assess the relationship between lower gastrointestinal symptoms and quality of life in conservativelytreated CKD patients. The full methodology of the study was described in a published paper [19]. Ethical permission for the study was obtained from the Bioethical Committee for Scientific Research at the Medical University of Gdańsk (NKBBN/426-56/2018).…”

“…All dimensions are scored such that higher scores indicate better HRQoL. Since general health scale in the Polish version of the SF-36v2 is neither reliable nor valid [19], we did not used results of this domain in this study. To use both the MOS-Sleep-R and the SF-36v2, a non-commercial license agreement was made between JR and OptumInsight Life Sciences, Inc. (license number: QM044526).…”

“…Data on gender, age, body weight, height, BMI, estimated glomerular filtration rate (eGFR) based on CKD-EPI formula, etiology of CKD, comorbidities and taken medications, were collected by a physician, as reported previously [19].…”

“…Out of 111 patients surveyed in our previous study for gastrointestinal symptoms and healthrelated quality of life [19], 100 patients completed MOS Sleep-R. Their demographic and clinical characteristics are presented in Table 1, while pharmacotherapy in Supplementary Materials, Table S1.…”

“…Since in our previous paper we found out several associations between constipation-related symptoms and decreased HRQoL in non-dialysis CKD patients [19], we performed analyzes to explore correlations between constipation-related symptoms and subjective sleep quality assessments (Table 3). Interestingly, abdominal and stool scales scores significantly correlated with all assessed sleep quality domains; the former correlations were stronger and more robust (coefficients have not changed after removal non-symptomatic patients from the analysis, data not shown).…”